HomeMy WebLinkAboutBuilding Permit Application 6
ALL APPLICABL NFO UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
�� � Permit Number: C
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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PROPOSED T10
PO N„ X �
Address: 7
Legal Description:
Property Tax ID#: Z - - C� - Lot NC✓V
Site Plan Name: — Block No. r
Project Name:
Setbacks Front Back: Right Side: Left Side:
CRIPT
DETAILED DfASC
4N OF:WORK
"-MAX"
FOD
CONSTRUCTION INFORMATION
Additional worR toe er orme un er this permit-check a apply:
HVAC E]Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
Electric ❑ Plumbing Sprinklers Generator ®Roof
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Total Sq. Ft of Construction: 7 � S . Ft.of First Floor: 9'07_U
Cost of Construction:$ �� Utilities: Sewer Septic Building Height:
:OWNER/LES5EE.. CaiVTRACTOR:
Name S�nn epsc&ajName-
Address: v /�- ompany: /`
City: cAddres 7
Zip Code: C 2�?- Fax: City: State:
Phone No. -7 —ao�— Zip Code: Fax':L7 o2.10y.3
E-Mail: Phone No. — [ S
11
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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S;I�PPLEMENTAL CONSTRUCTION LIENLA1111 INFORMATION;
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St.Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit,I do hereby agree that I will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Rec rd a Notice of Commencement may result in your paying twice for
improvements to your property. A N ce of Commencement must be recorded and posted on the jobsite
before the first inspe If yo tend to obtain financing, consult with lend an attorney bef
commencin ec rdi our Notice of Commencement.
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STVw r/Lessee/Agent Signat a of Co a cense Holder
EO LORIDQ - STAT FLORIDC �i�Wl COUNTY OF , l/I
Th: going instrument was acknowledg d before me The forgoing instrument was acknowledged before me
thi day of 20� by this day of 20 by
( a e of r n knowled i (Na of n 'c ow edgin
SHREIS
S SCHWAS
��` public
-State of Florida
yip ; Notary ion FF 205427 01 Florida
(Signature of14-� �tgoq{jJ9lfta (Signatur iif N nary Public�State of Floi{c� 9
"'.,�o n,rr' y u'ati° y`� :.pices Mar 201
Personally Kno OR Produced Identification Personally Known
',,0 _P�ff<cation
a ..
Type of Identi ication Produced Type of Identification Voduced
Commission No. (Seal) Commission No. a
wipe SHREISS SCHWAS
o`Par PbIIC-State of Florida
•: S ommission F
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Revised 07/15/2014 =,9 My Comm.Expires Mar 3,
2019
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